Objective: In the manuscript titled Monoamine Oxidase-B Inhibitor Rasagiline Effects on Motor and Non-Motor Symptoms in Individuals with Parkinsons Disease: A Systematic Review and Meta-Analysis, the objective was to ...Objective: In the manuscript titled Monoamine Oxidase-B Inhibitor Rasagiline Effects on Motor and Non-Motor Symptoms in Individuals with Parkinsons Disease: A Systematic Review and Meta-Analysis, the objective was to conduct a systematic review with meta-analysis to investigate the effects that Rasagiline has on motor and non-motor symptoms in individuals with PD. Introduction: Rasagiline is a second-generation monoamine oxidase-B (MAO-B) inhibitor used both as monotherapy and adjunctive therapy for Parkinsons Disease (PD). Methods: A systematic literature search and meta-analysis were performed with randomized control trials that investigated the effects of Rasagiline on motor and non-motor symptoms in individuals with PD. The systematic search was conducted in PubMed, Cochrane, and EBSCO databases. Methodological quality was assessed using the Cochrane Grading Recommendations Assessment, Development and Evaluation approach. Results: Fourteen studies were included in our review. There were trivial to small and statistically significant improvements in motor symptoms for individuals with PD treated with Rasagiline compared to placebo. Non-motor symptoms showed no significant improvement with Rasagiline compared to placebo in five of six meta-analyses. Results were based on very low to moderate certainty of evidence. Conclusion: 1 mg/day Rasagiline significantly improved Parkinsonian motor symptoms in individuals with PD compared with placebo. For all outcomes, the 1 mg/day Rasagiline group was favored over the placebo group.展开更多
Hanoi’s rapid urbanization has led to a surge in private vehicle ownership, particularly motorcycles, amidst inadequate public transportation infrastructure. Despite government efforts, many still prefer motorized tr...Hanoi’s rapid urbanization has led to a surge in private vehicle ownership, particularly motorcycles, amidst inadequate public transportation infrastructure. Despite government efforts, many still prefer motorized transport, citing mobility and safety concerns, exacerbated by insufficient pedestrian infrastructure. This study examines the motivations behind this reliance on motorized vehicles, particularly motorcycles, in Hanoi. Findings reveal safety and convenience as primary factors driving motorized transport use, especially for accessing bus stations. Economic incentives could promote non-motorized travel and public transport adoption. Policy implications highlight the importance of addressing economic factors and improving access infrastructure to manage motorized vehicle reliance and foster sustainable urban mobility in Hanoi.展开更多
Bicycling is an important way for college students and employees to get around campuses. With a rise in bicycling on campuses there comes a rise in bicycle collisions with pedestrians walking to and from classes and w...Bicycling is an important way for college students and employees to get around campuses. With a rise in bicycling on campuses there comes a rise in bicycle collisions with pedestrians walking to and from classes and work. The literature review showed many papers involving bicycle conflict modeling but on roads with motor vehicles. While some aspects of this research can be applied to non-motorized paths, there is a lack of research strictly focusing on only bicycles and pedestrians. This study aims to fill this knowledge gap by developing a model to identify locations on roads and paths (hotspots) on college campuses that are likely to have a bicycle collision and predict the likelihood of a serious bicycle crash on a non-motorized path based on the characteristics of the path. This study identifies those interactions between bicyclists and pedestrians on non-motorized paths on a suburban college campus in Newark, USA. Findings suggest that pedestrian density of a path is a major factor in the maximum speed bicyclists can achieve. The wider the path is, the higher the maximum speed is that a bicyclist can obtain. This is because a wider path width decreases the pedestrian density. The grade of the path has little effect on bicycle speeds. The results of the models were displayed on a GIS map that is visually appealing to a viewer. The paths were color coded based on their level of safety, so it is easy to observe problematic areas of the network. This technique can be applied to the entire campus network of non-motorized paths to study the whole system. This can then be used by planners and designers to identify areas that need upgrading and improve the overall safety of the non-motorized path system.展开更多
Motor symptoms are cardinal clinical features of Parkinson’s disease (PD). Progress in drug therapy and rehabilitation has been presenting beneficial effect for motor symptoms. However, non-motor symptoms and signs i...Motor symptoms are cardinal clinical features of Parkinson’s disease (PD). Progress in drug therapy and rehabilitation has been presenting beneficial effect for motor symptoms. However, non-motor symptoms and signs in PD have been accumulated growing attentions and its amelioration may also give beneficial effect for PD patients’ and their care givers’ quality of life. In this mini-review, I overviewed non-motor symptoms and signs in PD.展开更多
<strong>Background: </strong>Parkinson’s disease (PD) remains a challenge for neurologists, particularly in its advanced stages when non-motor symptoms become a burden for the patient. While motor symptom...<strong>Background: </strong>Parkinson’s disease (PD) remains a challenge for neurologists, particularly in its advanced stages when non-motor symptoms become a burden for the patient. While motor symptoms may be satisfactorily controlled with levodopa therapy or continuous levodopa/carbidopa intestinal gel (LCIG) administration, autonomic, sleep and mental disorders are hard to treat. During the last years, researchers have shifted their interest more to non-motor symptoms, PD being now considered a complex multiorgan impairment. <strong>Objective:</strong> The aim of this study was to describe non-motor symptoms in 40 Romanian patients diagnosed with PD, under conventional and LCIG administration treatment. <strong>Methods: </strong>A cross-sectional observational study was conducted, consisting of two groups of 20 patients each: the first group comprised PD patients who received conventional Levodopa treatment, while the second group was formed of patients receiving LCIG therapy. Various data concerning patient’s age, gender, duration of illness, comorbidities, motor and non-motor symptoms were recorded. The data were processed in SPSS v.20. <strong>Results: </strong>Subjects under continuous LCIG administration, although showing amelioration of motor symptoms, complained more frequently of constipation, mental, and sleeping disorders (statistically significant). Regarding anosmia, orthostatic hypotension, hypersalivation, urinary incontinence and restless legs syndrome, no statistical significant difference was observed between the two groups (p > 0.05). <strong>Conclusion:</strong> Nowadays, more research is conducted on non-motor symptoms in PD patients, as therapeutic measures try to limit these burdens, in order to improve patient’s quality of life.展开更多
Transportation systems provide a means for moving people and the goods from which they are spatially separated. Of the two means of surface transportation, the motorized mode is used extensively for utilitarian travel...Transportation systems provide a means for moving people and the goods from which they are spatially separated. Of the two means of surface transportation, the motorized mode is used extensively for utilitarian travel in developed countries. The increasing reliance on motorized travel has contributed to increased traffic congestion, air pollution, and greenhouse emissions. Non-motorized travel has recently received significant attention as a means to reduce congestion and environmental problems and improve human health. However, non-motorized modeling is generally underdeveloped. This study investigated some changes in non-motorized and total travel and the characteristics of the traveling public in 1990, 1995, 2001, and 2009 using a national travel survey. The study also investigated the temporal transferability of linear-regression trip generation models for non-motorized and total travel under such changes. High-income households made fewer non-motorized trips in 1990 and 1995 compared to 2001 and 2009. Persons aged 50 and over showed an increased demand for non-motorized travel, whereas children aged 0 - 15 showed a decreasing preference for non-motorized travel over time. Regarding temporal stability, only the coefficient for single-adult households with no children was stable across all of the analysis years. For both non-motorized and total travel, most model parameter estimates were stable short term but not long term. In general, the total travel models transferred better than non-motorized models, both short term and long term. Despite not finding universal stability in model parameter estimates, the models were marginally able to replicate travel in 2009 relative to the locally estimated 2009 model.展开更多
Under the background of"people-oriented"thought and"green transportation",the idea of"priority for non-motor vehicles"came into being,which can improve the riding environment of non-motor...Under the background of"people-oriented"thought and"green transportation",the idea of"priority for non-motor vehicles"came into being,which can improve the riding environment of non-motor vehicle riders to a certain extent.According to the current situation of priority for non-motor vehicles in the old urban area of Nanchang,through field investigation,questionnaire investigation and interview,this study summarized the existing problems,and put forward optimization suggestions for these problems,in order to provide reference for areas with similar conditions.展开更多
Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease. It is a complex syndrome with heterogeneous aetiologies, pathogenesis and manifestations. Patients with PD may...Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease. It is a complex syndrome with heterogeneous aetiologies, pathogenesis and manifestations. Patients with PD may present with motor symptoms and various non-motor symptoms (NMSs). NMSs have been reported in almost every diagnosed case of PD and usually precede motor symptoms. Multiple factors have been proved to be associated with the occurrence of NMSs in PD, among which genetic differentiation is a featured one. With the development of sequencing techniques, an increasing number of NMS-related genetic factors have been identified. This article reviews some of the latest discoveries in this regard.展开更多
With the deployment of Connected and Automated Vehicles in the coming decades,road transportation will experience a significant upheaval.CAVs(Connected and Autonomous Vehicles)have been a main emphasis of Transportati...With the deployment of Connected and Automated Vehicles in the coming decades,road transportation will experience a significant upheaval.CAVs(Connected and Autonomous Vehicles)have been a main emphasis of Transportation and the automotive sector,and the future of transportation system analysis is widely anticipated.The examination and future development of CAVs technology has been the subject of numerous researches.However,as three essential kinds of road users,pedestrians,bicyclists,and motorcyclists have experienced little to no handling.We explored the influence of CAVs on non-motorized mobility in this article and seven various issues that CAVs face in the environment.展开更多
Redesign of motorized and non-motorized transport in cities and sustainable mobility possibilities and utilization of already occupied areas for motorized and non-motorized transport in cities. Reserved area for publi...Redesign of motorized and non-motorized transport in cities and sustainable mobility possibilities and utilization of already occupied areas for motorized and non-motorized transport in cities. Reserved area for public transport may be the redesign much more to take advantage of without taking up new space in cities. Redesigned solutions shown in the work of public mass transport and the redesign of non-motorized transport, bicycle and pedestrian paths point to the improved use and safety of movement of passengers, cyclists and pedestrians. This paper presents five redesigned concept designs as improving existing forms of transport and movement of cyclists and pedestrians in cities. Redesigned conceptual designs of motorized and non-motorized transport in cities should serve as ideas for the growing problems of urban development in the segment of insufficient surface for pedestrians and cyclists, as well as sustainable mobility transport people in the city.展开更多
Parkinson’s disease patients,in addition to typical motor symptoms,often experience various psychological symptoms,including depression,anxiety,cognitive impairment,impulse control disorders,and psychotic symptoms.Th...Parkinson’s disease patients,in addition to typical motor symptoms,often experience various psychological symptoms,including depression,anxiety,cognitive impairment,impulse control disorders,and psychotic symptoms.These symptoms severely affect patients’quality of life and may even cause a greater disease burden than motor symptoms.This review focuses on the application progress of transcranial magnetic stimulation(TMS)as a non-invasive neuromodulation technique in the treatment of psychological symptoms in Parkinson’s disease.Studies have shown that repetitive TMS(rTMS)has significant improvement effects on Parkinson’s disease-related depressive symptoms,with mechanisms possibly related to the regulation of the prefrontal-striatal dopamine pathway and the promotion of neuroplasticity.For anxiety symptoms,continuous theta burst stimulation has shown potential in indirect regulation of the amygdala and hippocampal regions.For cognitive impairment,high-frequency rTMS applied to the dorsolateral prefrontal cortex can improve executive function deficits,while bilateral coordinated stimulation protocols help enhance attention and memory functions.For impulse control disorders in Parkinson’s disease patients,inhibitory stimulation applied to the orbitofrontal cortex can alleviate pathological gambling and compulsive behaviors.In terms of sleep disorders,TMS has also shown potential efficacy in regulating circadian rhythms and improving rapid eye movement sleep behavior disorder.However,current research still has limitations such as small sample sizes,non-standardized stimulation protocols,and insufficient evaluation of long-term efficacy.Future research directions should focus on optimizing stimulation parameters,exploring individualized treatment protocols,integrating multimodal imaging assessments,and conducting large-sample randomized controlled trials to clarify the clinical application value of TMS in the rehabilitation of psychological symptoms in Parkinson’s disease,providing new approaches for the comprehensive management of this common neurodegenerative disease.展开更多
背景:运动干预作为经济有效的非物理疗法,可有效上调脑源性神经营养因子表达进而防治帕金森病发生发展,但目前关于靶向脑源性神经营养因子的运动治疗策略在延缓帕金森病发生发展的潜在作用机制尚不明晰。目的:以脑源性神经营养因子和帕...背景:运动干预作为经济有效的非物理疗法,可有效上调脑源性神经营养因子表达进而防治帕金森病发生发展,但目前关于靶向脑源性神经营养因子的运动治疗策略在延缓帕金森病发生发展的潜在作用机制尚不明晰。目的:以脑源性神经营养因子和帕金森病的关系为切入点,分析帕金森病病理状态下运动对脑源性神经营养因子表达的特异性调控作用及机制,梳理脑源性神经营养因子介导下不同运动方式对帕金森病的改善效果,并阐明靶向脑源性神经营养因子的运动治疗策略在防治帕金森病的潜在作用机制,旨在为运动防治帕金森病提供新的理论依据。方法:以“帕金森病,脑源性神经营养因子,神经保护,多巴胺,神经元异常凋亡,神经炎症反应,突触可塑性,运动”等为中文检索词;以“Parkinson’s disease,BDNF,Neuroprotection,neuroinflammation,synaptic plasticity”等为英文检索词,分别检索中国知网、万方数据库、PubMed和Web of Science数据库,搜寻各数据库建库至2024年2月发表的所有研究文献,根据纳排标准共获得核心相关文献98篇。结果与结论:①在帕金森病理背景下,运动可通过促进肌因子鸢尾素大量分泌,并降低色氨酸-犬尿氨酸代谢途径紊乱特异性调控脑源性神经营养因子表达。②有氧运动,尤其是特殊有氧运动(动物:旋转杆步行/人类:北欧健走)以及多模式运动可显著上调脑源性神经营养因子表达,进而改善帕金森病的运动症状,此外脑源性神经营养因子还介导身心运动(太极拳)对帕金森病患者认知障碍和睡眠障碍等非运动症状的有效调节。③运动诱导的高表达脑源性神经营养因子可能通过上调抗炎因子白细胞介素10、神经生长因子β和转化生长因子β表达,下调促炎因子肿瘤坏死因子α及白细胞介素1β表达,并抑制核转录因子κB信号通路表达降低小胶质细胞活性减轻神经炎症反应;增加酪氨酸羟化酶活性以促进多巴胺合成释放,并通过下调基质金属蛋白酶3及糖原合成酶激酶3β表达抑制α-突触核蛋白在丝氨酸129位点的磷酸化修饰,以防止神经异常凋亡;诱导突触效能的长时程增强发生,促进突触后致密区蛋白95及突触素大量表达以改善突触可塑性,发挥神经保护作。④鉴于脑源性神经营养因子在帕金森病发病进程及治疗中发挥重要作用,靶向脑源性神经营养因子的运动治疗策略将有助于推动帕金森病疾病“运动+药物”精准医疗的发展。但由于目前研究采用的运动处方较为单一,且研究焦点主要围绕运动症状而缺乏对非运动症状的考察,因此亟待学者采用更加统一和系统的运动处方,围绕非有氧运动类型对同一批帕金森病患者进行长期纵向跟踪研究,以此完善帕金森病运动防治领域研究的不足。展开更多
文摘Objective: In the manuscript titled Monoamine Oxidase-B Inhibitor Rasagiline Effects on Motor and Non-Motor Symptoms in Individuals with Parkinsons Disease: A Systematic Review and Meta-Analysis, the objective was to conduct a systematic review with meta-analysis to investigate the effects that Rasagiline has on motor and non-motor symptoms in individuals with PD. Introduction: Rasagiline is a second-generation monoamine oxidase-B (MAO-B) inhibitor used both as monotherapy and adjunctive therapy for Parkinsons Disease (PD). Methods: A systematic literature search and meta-analysis were performed with randomized control trials that investigated the effects of Rasagiline on motor and non-motor symptoms in individuals with PD. The systematic search was conducted in PubMed, Cochrane, and EBSCO databases. Methodological quality was assessed using the Cochrane Grading Recommendations Assessment, Development and Evaluation approach. Results: Fourteen studies were included in our review. There were trivial to small and statistically significant improvements in motor symptoms for individuals with PD treated with Rasagiline compared to placebo. Non-motor symptoms showed no significant improvement with Rasagiline compared to placebo in five of six meta-analyses. Results were based on very low to moderate certainty of evidence. Conclusion: 1 mg/day Rasagiline significantly improved Parkinsonian motor symptoms in individuals with PD compared with placebo. For all outcomes, the 1 mg/day Rasagiline group was favored over the placebo group.
文摘Hanoi’s rapid urbanization has led to a surge in private vehicle ownership, particularly motorcycles, amidst inadequate public transportation infrastructure. Despite government efforts, many still prefer motorized transport, citing mobility and safety concerns, exacerbated by insufficient pedestrian infrastructure. This study examines the motivations behind this reliance on motorized vehicles, particularly motorcycles, in Hanoi. Findings reveal safety and convenience as primary factors driving motorized transport use, especially for accessing bus stations. Economic incentives could promote non-motorized travel and public transport adoption. Policy implications highlight the importance of addressing economic factors and improving access infrastructure to manage motorized vehicle reliance and foster sustainable urban mobility in Hanoi.
文摘Bicycling is an important way for college students and employees to get around campuses. With a rise in bicycling on campuses there comes a rise in bicycle collisions with pedestrians walking to and from classes and work. The literature review showed many papers involving bicycle conflict modeling but on roads with motor vehicles. While some aspects of this research can be applied to non-motorized paths, there is a lack of research strictly focusing on only bicycles and pedestrians. This study aims to fill this knowledge gap by developing a model to identify locations on roads and paths (hotspots) on college campuses that are likely to have a bicycle collision and predict the likelihood of a serious bicycle crash on a non-motorized path based on the characteristics of the path. This study identifies those interactions between bicyclists and pedestrians on non-motorized paths on a suburban college campus in Newark, USA. Findings suggest that pedestrian density of a path is a major factor in the maximum speed bicyclists can achieve. The wider the path is, the higher the maximum speed is that a bicyclist can obtain. This is because a wider path width decreases the pedestrian density. The grade of the path has little effect on bicycle speeds. The results of the models were displayed on a GIS map that is visually appealing to a viewer. The paths were color coded based on their level of safety, so it is easy to observe problematic areas of the network. This technique can be applied to the entire campus network of non-motorized paths to study the whole system. This can then be used by planners and designers to identify areas that need upgrading and improve the overall safety of the non-motorized path system.
文摘Motor symptoms are cardinal clinical features of Parkinson’s disease (PD). Progress in drug therapy and rehabilitation has been presenting beneficial effect for motor symptoms. However, non-motor symptoms and signs in PD have been accumulated growing attentions and its amelioration may also give beneficial effect for PD patients’ and their care givers’ quality of life. In this mini-review, I overviewed non-motor symptoms and signs in PD.
文摘<strong>Background: </strong>Parkinson’s disease (PD) remains a challenge for neurologists, particularly in its advanced stages when non-motor symptoms become a burden for the patient. While motor symptoms may be satisfactorily controlled with levodopa therapy or continuous levodopa/carbidopa intestinal gel (LCIG) administration, autonomic, sleep and mental disorders are hard to treat. During the last years, researchers have shifted their interest more to non-motor symptoms, PD being now considered a complex multiorgan impairment. <strong>Objective:</strong> The aim of this study was to describe non-motor symptoms in 40 Romanian patients diagnosed with PD, under conventional and LCIG administration treatment. <strong>Methods: </strong>A cross-sectional observational study was conducted, consisting of two groups of 20 patients each: the first group comprised PD patients who received conventional Levodopa treatment, while the second group was formed of patients receiving LCIG therapy. Various data concerning patient’s age, gender, duration of illness, comorbidities, motor and non-motor symptoms were recorded. The data were processed in SPSS v.20. <strong>Results: </strong>Subjects under continuous LCIG administration, although showing amelioration of motor symptoms, complained more frequently of constipation, mental, and sleeping disorders (statistically significant). Regarding anosmia, orthostatic hypotension, hypersalivation, urinary incontinence and restless legs syndrome, no statistical significant difference was observed between the two groups (p > 0.05). <strong>Conclusion:</strong> Nowadays, more research is conducted on non-motor symptoms in PD patients, as therapeutic measures try to limit these burdens, in order to improve patient’s quality of life.
文摘Transportation systems provide a means for moving people and the goods from which they are spatially separated. Of the two means of surface transportation, the motorized mode is used extensively for utilitarian travel in developed countries. The increasing reliance on motorized travel has contributed to increased traffic congestion, air pollution, and greenhouse emissions. Non-motorized travel has recently received significant attention as a means to reduce congestion and environmental problems and improve human health. However, non-motorized modeling is generally underdeveloped. This study investigated some changes in non-motorized and total travel and the characteristics of the traveling public in 1990, 1995, 2001, and 2009 using a national travel survey. The study also investigated the temporal transferability of linear-regression trip generation models for non-motorized and total travel under such changes. High-income households made fewer non-motorized trips in 1990 and 1995 compared to 2001 and 2009. Persons aged 50 and over showed an increased demand for non-motorized travel, whereas children aged 0 - 15 showed a decreasing preference for non-motorized travel over time. Regarding temporal stability, only the coefficient for single-adult households with no children was stable across all of the analysis years. For both non-motorized and total travel, most model parameter estimates were stable short term but not long term. In general, the total travel models transferred better than non-motorized models, both short term and long term. Despite not finding universal stability in model parameter estimates, the models were marginally able to replicate travel in 2009 relative to the locally estimated 2009 model.
文摘Under the background of"people-oriented"thought and"green transportation",the idea of"priority for non-motor vehicles"came into being,which can improve the riding environment of non-motor vehicle riders to a certain extent.According to the current situation of priority for non-motor vehicles in the old urban area of Nanchang,through field investigation,questionnaire investigation and interview,this study summarized the existing problems,and put forward optimization suggestions for these problems,in order to provide reference for areas with similar conditions.
文摘Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease. It is a complex syndrome with heterogeneous aetiologies, pathogenesis and manifestations. Patients with PD may present with motor symptoms and various non-motor symptoms (NMSs). NMSs have been reported in almost every diagnosed case of PD and usually precede motor symptoms. Multiple factors have been proved to be associated with the occurrence of NMSs in PD, among which genetic differentiation is a featured one. With the development of sequencing techniques, an increasing number of NMS-related genetic factors have been identified. This article reviews some of the latest discoveries in this regard.
文摘With the deployment of Connected and Automated Vehicles in the coming decades,road transportation will experience a significant upheaval.CAVs(Connected and Autonomous Vehicles)have been a main emphasis of Transportation and the automotive sector,and the future of transportation system analysis is widely anticipated.The examination and future development of CAVs technology has been the subject of numerous researches.However,as three essential kinds of road users,pedestrians,bicyclists,and motorcyclists have experienced little to no handling.We explored the influence of CAVs on non-motorized mobility in this article and seven various issues that CAVs face in the environment.
文摘Redesign of motorized and non-motorized transport in cities and sustainable mobility possibilities and utilization of already occupied areas for motorized and non-motorized transport in cities. Reserved area for public transport may be the redesign much more to take advantage of without taking up new space in cities. Redesigned solutions shown in the work of public mass transport and the redesign of non-motorized transport, bicycle and pedestrian paths point to the improved use and safety of movement of passengers, cyclists and pedestrians. This paper presents five redesigned concept designs as improving existing forms of transport and movement of cyclists and pedestrians in cities. Redesigned conceptual designs of motorized and non-motorized transport in cities should serve as ideas for the growing problems of urban development in the segment of insufficient surface for pedestrians and cyclists, as well as sustainable mobility transport people in the city.
文摘Parkinson’s disease patients,in addition to typical motor symptoms,often experience various psychological symptoms,including depression,anxiety,cognitive impairment,impulse control disorders,and psychotic symptoms.These symptoms severely affect patients’quality of life and may even cause a greater disease burden than motor symptoms.This review focuses on the application progress of transcranial magnetic stimulation(TMS)as a non-invasive neuromodulation technique in the treatment of psychological symptoms in Parkinson’s disease.Studies have shown that repetitive TMS(rTMS)has significant improvement effects on Parkinson’s disease-related depressive symptoms,with mechanisms possibly related to the regulation of the prefrontal-striatal dopamine pathway and the promotion of neuroplasticity.For anxiety symptoms,continuous theta burst stimulation has shown potential in indirect regulation of the amygdala and hippocampal regions.For cognitive impairment,high-frequency rTMS applied to the dorsolateral prefrontal cortex can improve executive function deficits,while bilateral coordinated stimulation protocols help enhance attention and memory functions.For impulse control disorders in Parkinson’s disease patients,inhibitory stimulation applied to the orbitofrontal cortex can alleviate pathological gambling and compulsive behaviors.In terms of sleep disorders,TMS has also shown potential efficacy in regulating circadian rhythms and improving rapid eye movement sleep behavior disorder.However,current research still has limitations such as small sample sizes,non-standardized stimulation protocols,and insufficient evaluation of long-term efficacy.Future research directions should focus on optimizing stimulation parameters,exploring individualized treatment protocols,integrating multimodal imaging assessments,and conducting large-sample randomized controlled trials to clarify the clinical application value of TMS in the rehabilitation of psychological symptoms in Parkinson’s disease,providing new approaches for the comprehensive management of this common neurodegenerative disease.
文摘背景:运动干预作为经济有效的非物理疗法,可有效上调脑源性神经营养因子表达进而防治帕金森病发生发展,但目前关于靶向脑源性神经营养因子的运动治疗策略在延缓帕金森病发生发展的潜在作用机制尚不明晰。目的:以脑源性神经营养因子和帕金森病的关系为切入点,分析帕金森病病理状态下运动对脑源性神经营养因子表达的特异性调控作用及机制,梳理脑源性神经营养因子介导下不同运动方式对帕金森病的改善效果,并阐明靶向脑源性神经营养因子的运动治疗策略在防治帕金森病的潜在作用机制,旨在为运动防治帕金森病提供新的理论依据。方法:以“帕金森病,脑源性神经营养因子,神经保护,多巴胺,神经元异常凋亡,神经炎症反应,突触可塑性,运动”等为中文检索词;以“Parkinson’s disease,BDNF,Neuroprotection,neuroinflammation,synaptic plasticity”等为英文检索词,分别检索中国知网、万方数据库、PubMed和Web of Science数据库,搜寻各数据库建库至2024年2月发表的所有研究文献,根据纳排标准共获得核心相关文献98篇。结果与结论:①在帕金森病理背景下,运动可通过促进肌因子鸢尾素大量分泌,并降低色氨酸-犬尿氨酸代谢途径紊乱特异性调控脑源性神经营养因子表达。②有氧运动,尤其是特殊有氧运动(动物:旋转杆步行/人类:北欧健走)以及多模式运动可显著上调脑源性神经营养因子表达,进而改善帕金森病的运动症状,此外脑源性神经营养因子还介导身心运动(太极拳)对帕金森病患者认知障碍和睡眠障碍等非运动症状的有效调节。③运动诱导的高表达脑源性神经营养因子可能通过上调抗炎因子白细胞介素10、神经生长因子β和转化生长因子β表达,下调促炎因子肿瘤坏死因子α及白细胞介素1β表达,并抑制核转录因子κB信号通路表达降低小胶质细胞活性减轻神经炎症反应;增加酪氨酸羟化酶活性以促进多巴胺合成释放,并通过下调基质金属蛋白酶3及糖原合成酶激酶3β表达抑制α-突触核蛋白在丝氨酸129位点的磷酸化修饰,以防止神经异常凋亡;诱导突触效能的长时程增强发生,促进突触后致密区蛋白95及突触素大量表达以改善突触可塑性,发挥神经保护作。④鉴于脑源性神经营养因子在帕金森病发病进程及治疗中发挥重要作用,靶向脑源性神经营养因子的运动治疗策略将有助于推动帕金森病疾病“运动+药物”精准医疗的发展。但由于目前研究采用的运动处方较为单一,且研究焦点主要围绕运动症状而缺乏对非运动症状的考察,因此亟待学者采用更加统一和系统的运动处方,围绕非有氧运动类型对同一批帕金森病患者进行长期纵向跟踪研究,以此完善帕金森病运动防治领域研究的不足。
